Coordinator, Complaint & Appeals, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

18.50 - 35.29 USD / Hour

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Job Description:

Responsible for oversight of investigations and resolution of appeals scenarios for all products, which may contain multiple issues and may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals. Identify trends and emerging issues and report and recommend solutions.

Job Responsibility:

Oversight of investigations and resolution of appeals scenarios for all products
Ensure timely, customer focused response to appeals
Identify trends and emerging issues and report and recommend solutions
Independently coach others on appeals ensuring compliance with Federal and/or State regulations
Manage control and trend inventory
Investigate and resolve the most escalated cases from internal and external constituents
Serve as point of contact for appeals inquiries from leadership, compliance and State regulators
Research incoming electronic appeals, complaints and grievances
Research Standard Plan Design or Certification of Coverage to determine accuracy of benefit/administrative denial
Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status

Requirements:

At least 2+ years in one of the following areas: claim platforms, products, and benefits
patient management
product or contract drafting
compliance and regulatory analysis
special investigations
provider relations
customer service or audit experience
High School or GED

Nice to have:

Some Medicare and/or Medicaid knowledge
Experience in reading or researching benefit language
Ability to work in fast paced, high volume environment
Excellent verbal and written communication skills
Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics
Solution driven and can handle complex issues with accuracy

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 29, 2025

Expiration:
November 28, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Coordinator, Complaint & Appeals